TRICARE; Hospital Outpatient Radiology Discretionary Appeal Adjustments, 49458-49459 [2011-20235]

Download as PDF 49458 Federal Register / Vol. 76, No. 154 / Wednesday, August 10, 2011 / Notices and transfer to the Washington National Records Center, destroy 6 years and 3 months after period covered by account. Electronic Records are deleted from the database, paper records are destroyed by shredding or burning. SYSTEM MANAGER(S) AND ADDRESS: Chief, Financial Policy, Financial Operations, and Managerial Accounting Branch, Defense Intelligence Agency, 600 MacDill Blvd., Washington, DC 20340–5100. NOTIFICATION PROCEDURE: Individuals seeking to determine whether information about themselves is contained in this system of records should address written inquiries to the DIA Freedom of Information Office (DAN–1A), Defense Intelligence Agency, 200 MacDill Blvd., Washington, DC 20340–5100. Request should contain the individual’s full name, current address, and telephone number. RECORD ACCESS PROCEDURES: Individuals seeking access to information about themselves, contained in this system of records, should address written inquiries to the DIA Freedom of Information Office (DAN–1A), 200 MacDill Blvd., Washington, DC 20340–5100. Request should contain the individual’s full name, current address, and telephone number. [FR Doc. 2011–20237 Filed 8–9–11; 8:45 am] CONTESTING RECORD PROCEDURES: DIA’s rules for accessing records, for contesting contents and appealing initial agency determinations are published in DIA Instruction 5400.001 ‘‘Defense Intelligence Agency Privacy Program’’; or may be obtained from the system manager. RECORD SOURCE CATEGORIES: Individuals; DoD and other Federal, state and local financial records systems; financial, educational and medical institutions; and open source information, such as property tax records. emcdonald on DSK2BSOYB1PROD with NOTICES Jkt 223001 DEPARTMENT OF DEFENSE Office of the Secretary TRICARE, Formerly Known as the Civilian Health and Medical Program of the Uniformed Services (CHAMPUS); Fiscal Year 2012 Continued Health Care Benefit Program Premium Update Office of the Secretary, DoD. Notice of Updated Continued Health Care Benefit Program Premiums for Fiscal Year 2012. ACTION: During the course of Accounts Receivable, Indebtedness and Claims actions, exempt materials from other systems of records may in turn become part of the case records in this system. To the extent that copies of exempt records from those ‘other’ systems of records are entered into this correspondence case record, the Defense Intelligence Agency hereby claims the same exemptions for the records from those ‘other’ systems that are entered into this system, as claimed for the 17:48 Aug 09, 2011 BILLING CODE 5001–06–P AGENCY: EXEMPTIONS CLAIMED FOR THE SYSTEM: VerDate Mar<15>2010 original primary systems of records which they are a part. Records are only exempt from pertinent provisions of 5 U.S.C. 552a to the extent such provisions have been identified and an exemption claimed for the original record and the purposes underlying the exemption for the original record still pertain to the record which is now contained in this system of records. In general, the exemptions were claimed in order to protect properly classified information relating to national defense and foreign policy, to avoid interference during the conduct of criminal, civil, or administrative actions or investigations, to ensure protective services provided the President and others are not compromised, to protect the identity of confidential sources incident to Federal employment, military service, contract, and security clearance determinations, to preserve the confidentiality and integrity of Federal testing materials, and to safeguard evaluation materials used for military promotions when furnished by a confidential source. The exemption rule for the original records will identify the specific reasons why the records are exempt from specific provisions of 5 U.S.C. 552a. An exemption rule for this system has been promulgated in accordance with the requirements of 5 U.S.C 553(b)(1), (2), and (3), (c) and (e) and published in 32 CFR part 319. This notice provides the updated Continued Health Care Benefit Program premiums for Fiscal Year 2012. CHCBP is a premium-based health care program that offers transitional health coverage after TRICARE eligibility ends. CHCBP benefits are comparable to TRICARE Standard with similar benefits, providers, and program rules. DATES: Effective Date: The Fiscal Year 2012 rates contained in this notice are effective for services on or after October 1, 2011. SUMMARY: PO 00000 Frm 00028 Fmt 4703 Sfmt 4703 ADDRESSES: TRICARE Management Activity (TMA), Policy and Benefits Branch, 5111 Leesburg Pike, Suite 810A, Falls Church, VA 22041. FOR FURTHER INFORMATION CONTACT: Mark A. Ellis, telephone (703) 681– 0039. SUPPLEMENTARY INFORMATION: The final rule published in the Federal Register on September 30, 1994, (59 FR 49818) set forth rules to implement the Continued Health Care Benefit Program (CHCBP) required by 10 United States Code § 1078a. CHCBP is a premiumbased health care program that offers transitional health coverage after TRICARE eligibility ends. CHCBP benefits are comparable to TRICARE Standard with similar benefits, providers, and program rules. Included in this final rule were provisions for updating the CHCBP premiums for each federal Fiscal Year. As stated in the final rule, the premiums are based on Federal Employee Health Benefit Program employee and agency contributions required for a comparable health benefits plan, plus an administrative fee. Premiums may be revised annually and shall be published annually for each Fiscal Year. The TRICARE Management Activity has updated the quarterly premiums for Fiscal Year 2012 as shown below. Quarterly CHCBP Premiums for Fiscal Year 2012 Individual—$1,065. Family—$2,390. The above premiums are effective for services rendered on or after October 1, 2011. Dated: July 8, 2011. Patricia Toppings, OSD Federal Register Liaison Officer, Department of Defense. [FR Doc. 2011–20236 Filed 8–9–11; 8:45 am] BILLING CODE 5001–06–P DEPARTMENT OF DEFENSE Office of the Secretary TRICARE; Hospital Outpatient Radiology Discretionary Appeal Adjustments AGENCY: Office of the Secretary, Department of Defense (DoD). ACTION: Notice. SUMMARY: This notice is to advise hospitals of an opportunity for net adjusted payments for radiology services for which TRICARE payments were not comparable to the preOutpatient Prospective Payment System (OPPS) Medicare fair rates for the period E:\FR\FM\10AUN1.SGM 10AUN1 Federal Register / Vol. 76, No. 154 / Wednesday, August 10, 2011 / Notices August 1, 2003, to May 1, 2009 (or other appropriate end date for OPPS-exempt hospitals.) DATES: The agency must receive a hospital’s request on or before June 23, 2011, or October 11, 2011 for hospitals that did not receive notification by letter. TRICARE Management Activity (TMA), Medical Benefits and Reimbursement Branch, 16401 East Centretech Parkway, Aurora, CO 80011– 9066. FOR FURTHER INFORMATION CONTACT: Martha M. Maxey, Medical Benefits and Reimbursement Branch, TMA, telephone (303) 676–3627. SUPPLEMENTARY INFORMATION: In reviewing payments for hospital outpatient services, DoD has determined that, for radiology services specified in the regulation as being reimbursed under the allowable charge methodology, the technical component of the allowable charge did not approximate the Medicare fair payment for such hospital services as well as it could have. That is, in looking at the Medicare reimbursement methodologies in existence prior to adoption of Medicare’s OPPS in 2000, (methodologies resulting in fair payment for Federal health care, which TRICARE allowable charges for hospitals outpatient services were intended to emulate), some radiology services were underpaid in comparison. The National Defense Authorization Act for Fiscal Year 2002 required that TRICARE use Medicare reimbursement rates for hospitals to the extent practicable. While payments were made in accordance with 32 Code of Federal Regulation, 199.14, there is a basis for TRICARE to make discretionary net adjusted payments for radiology services for which TRICARE payments were not comparable to the pre-OPPS Medicare fair rates for the period in question. On April 25, 2011, TMA mailed letters to thousands of hospitals notifying them of this opportunity. The hospitals (or their recovery agents) have until June 23, 2011, 60 days from the date of notification, to file an appeal for pay adjustments that will be adjudicated by TMA. Hospitals that did not receive notification by mail have 60 days from August 10, 2011. Critical Access Hospitals (CAHs) which are not subject to TRICARE’s OPPS shall submit a request for the period August 1, 2003, to November 30, 2009. As of December 1, 2010, the payments to CAHs are based on reasonable cost and thus potential emcdonald on DSK2BSOYB1PROD with NOTICES ADDRESSES: VerDate Mar<15>2010 17:48 Aug 09, 2011 Jkt 223001 adjustments would not apply. Other hospitals not subject to OPPS (such as Cancer and Children’s hospitals) shall submit a request for the period August 1, 2003, to December 31, 2010. The payment adjustment process along with the notification letter to hospitals can be viewed at TMA’s Web site at: https://www.tricare.mil/Radiology DiscretionaryAppealAdjustments. Dated: July 8, 2011. Patricia Toppings, OSD Federal Register Liaison Officer, Department of Defense. [FR Doc. 2011–20235 Filed 8–9–11; 8:45 am] BILLING CODE 5001–06–P DEPARTMENT OF EDUCATION Notice of Proposed Information Collection Requests Department of Education. Comment request. AGENCY: ACTION: SUMMARY: The Department of Education (the Department), in accordance with the Paperwork Reduction Act of 1995 (PRA) (44 U.S.C. 3506(c)(2)(A)), provides the general public and Federal agencies with an opportunity to comment on proposed and continuing collections of information. This helps the Department assess the impact of its information collection requirements and minimize the reporting burden on the public and helps the public understand the Department’s information collection requirements and provide the requested data in the desired format. The Director, Information Collection Clearance Division, Regulatory Information Management Services, Office of Management, invites comments on the proposed information collection requests as required by the Paperwork Reduction Act of 1995. DATES: Interested persons are invited to submit comments on or before October 11, 2011. ADDRESSES: Comments regarding burden and/or the collection activity requirements should be electronically mailed to ICDocketMgr@ed.gov or mailed to U.S. Department of Education, 400 Maryland Avenue, SW., LBJ, Washington, DC 20202–4537. Please note that written comments received in response to this notice will be considered public records. SUPPLEMENTARY INFORMATION: Section 3506 of the Paperwork Reduction Act of 1995 (44 U.S.C. chapter 35) requires that Federal agencies provide interested parties an early opportunity to comment on information collection requests. The Director, Information Collection PO 00000 Frm 00029 Fmt 4703 Sfmt 4703 49459 Clearance Division, Regulatory Information Management Services, Office of Management, publishes this notice containing proposed information collection requests at the beginning of the Departmental review of the information collection. The Department of Education is especially interested in public comment addressing the following issues: (1) Is this collection necessary to the proper functions of the Department; (2) will this information be processed and used in a timely manner; (3) is the estimate of burden accurate; (4) how might the Department enhance the quality, utility, and clarity of the information to be collected; and (5) how might the Department minimize the burden of this collection on the respondents, including through the use of information technology. Dated: August 4, 2011. Darrin A. King, Director, Information Collection Clearance Division, Regulatory Information Management Services, Office of Management. Institute of Education Sciences Type of Review: New. Title of Collection: Teaching and Learning International Survey (TALIS) 2013 Field Trial. OMB Control Number: Pending . Agency Form Number(s): N/A. Frequency of Responses: Annually. Affected Public: Individuals or households. Total Estimated Number of Annual Responses: 594. Total Estimated Number of Annual Burden Hours: 1,265. Abstract: Teaching and Learning International Survey (TALIS), is an international survey of the teaching workforce, teaching as a profession, and the learning environments of schools. Data are collected through questionnaires from individual teachers and their school principals in lower secondary schools (grades 7, 8 and 9) in the United States. TALIS’ main objective is to help countries review current policy and develop informed education policy by providing accurate and relevant international indicators on teachers and teaching. TALIS offers an opportunity for teachers and school principals to provide their perspectives on the state of education in their own countries. Both teacher and principal questionnaires include questions about teacher and principal background and characteristics; teacher and principal professional development; school leadership and management; teacher appraisal and feedback; teachers’ instructional beliefs and pedagogical practices; school climate and ethos; E:\FR\FM\10AUN1.SGM 10AUN1

Agencies

[Federal Register Volume 76, Number 154 (Wednesday, August 10, 2011)]
[Notices]
[Pages 49458-49459]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 2011-20235]


-----------------------------------------------------------------------

DEPARTMENT OF DEFENSE

Office of the Secretary


TRICARE; Hospital Outpatient Radiology Discretionary Appeal 
Adjustments

AGENCY: Office of the Secretary, Department of Defense (DoD).

ACTION: Notice.

-----------------------------------------------------------------------

SUMMARY: This notice is to advise hospitals of an opportunity for net 
adjusted payments for radiology services for which TRICARE payments 
were not comparable to the pre-Outpatient Prospective Payment System 
(OPPS) Medicare fair rates for the period

[[Page 49459]]

August 1, 2003, to May 1, 2009 (or other appropriate end date for OPPS-
exempt hospitals.)

DATES: The agency must receive a hospital's request on or before June 
23, 2011, or October 11, 2011 for hospitals that did not receive 
notification by letter.

ADDRESSES: TRICARE Management Activity (TMA), Medical Benefits and 
Reimbursement Branch, 16401 East Centretech Parkway, Aurora, CO 80011-
9066.

FOR FURTHER INFORMATION CONTACT: Martha M. Maxey, Medical Benefits and 
Reimbursement Branch, TMA, telephone (303) 676-3627.

SUPPLEMENTARY INFORMATION: In reviewing payments for hospital 
outpatient services, DoD has determined that, for radiology services 
specified in the regulation as being reimbursed under the allowable 
charge methodology, the technical component of the allowable charge did 
not approximate the Medicare fair payment for such hospital services as 
well as it could have. That is, in looking at the Medicare 
reimbursement methodologies in existence prior to adoption of 
Medicare's OPPS in 2000, (methodologies resulting in fair payment for 
Federal health care, which TRICARE allowable charges for hospitals 
outpatient services were intended to emulate), some radiology services 
were underpaid in comparison.
    The National Defense Authorization Act for Fiscal Year 2002 
required that TRICARE use Medicare reimbursement rates for hospitals to 
the extent practicable. While payments were made in accordance with 32 
Code of Federal Regulation, 199.14, there is a basis for TRICARE to 
make discretionary net adjusted payments for radiology services for 
which TRICARE payments were not comparable to the pre-OPPS Medicare 
fair rates for the period in question.
    On April 25, 2011, TMA mailed letters to thousands of hospitals 
notifying them of this opportunity. The hospitals (or their recovery 
agents) have until June 23, 2011, 60 days from the date of 
notification, to file an appeal for pay adjustments that will be 
adjudicated by TMA. Hospitals that did not receive notification by mail 
have 60 days from August 10, 2011.
    Critical Access Hospitals (CAHs) which are not subject to TRICARE's 
OPPS shall submit a request for the period August 1, 2003, to November 
30, 2009. As of December 1, 2010, the payments to CAHs are based on 
reasonable cost and thus potential adjustments would not apply. Other 
hospitals not subject to OPPS (such as Cancer and Children's hospitals) 
shall submit a request for the period August 1, 2003, to December 31, 
2010.
    The payment adjustment process along with the notification letter 
to hospitals can be viewed at TMA's Web site at: https://www.tricare.mil/RadiologyDiscretionaryAppealAdjustments.

    Dated: July 8, 2011.
Patricia Toppings,
OSD Federal Register Liaison Officer, Department of Defense.
[FR Doc. 2011-20235 Filed 8-9-11; 8:45 am]
BILLING CODE 5001-06-P
This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.